March 11, 2021
Policy Article Revisions Summary for March 11, 2021
Outlined below are the principal changes to the DME MAC Policy Articles (PAs) that have been revised and posted. The policies included are Ankle-Foot/Knee-Ankle-Foot Orthoses, Oral Antiemetic Drugs (Replacement for Intravenous Antiemetics), Orthopedic Footwear, Osteogenesis Stimulators, Speech Generating Devices (SGD), Spinal Orthoses: TLSO and LSO, Standard Documentation Requirements for All Claims Submitted to DME MACs and Vacuum Erection Devices (VED). Please review the entire LCDs and related PAs for complete information.
Ankle-Foot/Knee-Ankle-Foot Orthoses
PA
Ankle-Foot/Knee-Ankle-Foot Orthoses PA
Revision Effective Date: 02/01/2021
CODING GUIDELINES:
- Removed: Coding verification review information for HCPCS codes L1906 and L2006
CODING VERIFICATION REVIEW:
- Added: Section header and PDAC coding verification review information
- Added: Coding verification review information for HCPCS codes L1906 and L2006
03/11/2021: At this time 21st Century Cures Act applies to new and revised LCDs which require comment and notice. This revision is to an article that is not a local coverage determination.
Oral Antiemetic Drugs (Replacement for Intravenous Antiemetics)
PA
Oral Antiemetic Drugs (Replacement for Intravenous Antiemetics) PA
Revision Effective Date: 01/01/2020
POLICY SPECIFIC DOCUMENTATION REQUIREMENTS:
- Removed: HCPCS Codes Q0981 and Q9978 which are no longer valid for billing
CODING GUIDELINES:
- Removed: HCPCS Codes Q9978 and Q9981 which are no longer valid for billing
03/11/2021: At this time 21st Century Cures Act applies to new and revised LCDs which require comment and notice. This revision is to an article that is not a local coverage determination.
Orthopedic Footwear
PA
Revision Effective Date: 01/01/2020
NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES:
- Added: HCPCS code L3000 to noncovered statement, previously omitted in error
03/11/2021: At this time 21st Century Cures Act applies to new and revised LCDs which require comment and notice. This revision is to an article that is not a local coverage determination.
Osteogenesis Stimulators
PA
Revision Effective Date: 01/01/2020
POLICY SPECIFIC DOCUMENTATION REQUIREMENTS:
- Added: Class III devices and KF modifier requirement for HCPCS codes E0747, E0748 and E0760
CODING GUIDELINES:
- Removed: Class III devices and KF modifier requirements which were moved to the Policy Specific Documentation Requirements section
03/11/2021: At this time 21st Century Cures Act applies to new and revised LCDs which require comment and notice. This revision is to an article that is not a local coverage determination.
Speech Generating Devices (SGD)
PA
Speech Generating Devices (SGD) PA
Revision Effective Date: 01/01/2020
CODING GUIDELINES:
- Added: “(PCL)” after reference to “Product Classification List”
- Revised: Coding verification review information, to include incorrect coding denial language for products billed using HCPCS that require written coding verification review
03/11/2021: At this time 21st Century Cures Act applies to new and revised LCDs which require comment and notice. This revision is to an article that is not a local coverage determination.
Spinal Orthoses: TLSO and LSO
PA
Spinal Orthoses: TLSO and LSO PA
Revision Effective Date: 02/01/2021
CODING GUIDELINES:
- Removed: Reference to L0640 from list of prefabricated orthoses
- Removed: HCPCS codes L0622 and L0624 from list of custom fabricated orthoses for which all products must be listed on the PCL
- Added: “(PCL)” after reference to “Product Classification List”
- Revised: Coding verification review information, to include incorrect coding denial language for products billed using HCPCS that require written coding verification review
03/11/2021: At this time 21st Century Cures Act applies to new and revised LCDs which require comment and notice. This revision is to an article that is not a local coverage determination.
Standard Documentation Requirements for All Claims Submitted to DME MACs
PA
Standard Documentation Requirements for All Claims Submitted to DME MACs PA
STANDARD WRITTEN ORDER (SWO):
- Revised: Reference to the Medicare Program Integrity Manual from 'Internet only manual' to 'CMS Pub.'
DOCUMENTATION REQUIREMENTS:
- Revised: “DME MAC supplier” to “DMEPOS supplier” in second paragraph
CORRECT CODING:
- Revised: Reference to the Medicare Program Integrity Manual from 'Internet only manual' to 'CMS Pub.'
- Added: “45 CFR” in front of 162.1002 reference in first paragraph
- Revised: ‘Durable Medical Equipment Coding System’ reference to ‘DMECS’ to match the PDAC website
REPAIRS/REPLACEMENT:
- Revised: References to the Medicare Benefit Policy Manual from 'Internet only manual' to 'CMS Pub.'
SIGNATURE REQUIREMENTS:
- Revised: Reference to the Medicare Program Integrity Manual from 'Internet only manual' to 'CMS Pub.'
03/11/2021: At this time 21st Century Cures Act applies to new and revised LCDs which require comment and notice. This revision is to an article that is not a local coverage determination.
Vacuum Erection Devices (VED)
PA
Vacuum Erection Devices (VED) PA
Revision Effective Date: 01/01/2020
NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES:
- Added: Social Security Act citation for non-coverage 1834(a)(1)(I)
03/11/2021: At this time 21st Century Cures Act applies to new and revised LCDs which require comment and notice. This revision is to an article that is not a local coverage determination.
Note: The information contained in this article is only a summary of revisions to the LCDs and PAs. For complete information on any topic, you must review the LCDs and/or PAs.